Risk factors for infant mortality in a municipality in southern Brazil: a comparison of two cohorts using hierarchical analysis

Abstract

This study compared risk factors for infant mortality in 2000-2001 and 2007-2008 in Londrina, Paraná State, Brazil. Data on live births and infant deaths were linked in a single database, and a hierarchical regression model was used. Distal risk factors for infant mortality in 2000-2001 were maternal age < 20 or ≥ 35 years and lower maternal schooling. In 2007-2008, maternal age ≥ 35 or < 20 years were risk factors, while low schooling appeared as a protective factor. The following intermediate factors were associated with increased infant mortality in 2000-2001: multiple pregnancy, history of stillbirth, and insufficient number of prenatal visits, while cesarean delivery was a protective factor. Multiple pregnancy was the only intermediate risk factor in 2007-2008. All of the proximal factors were associated with higher infant mortality in 2000-2001, but only gestational age and 5-minute Apgar in 2007-2008. The risk factors for infant mortality changed from the first to the second cohort, which may be related to the expansion of social policies and primary care and changes in the reproductive and social patterns of Brazilian women.

Mortalidade infantil: tendência temporal e contribuição da vigilância do óbito

“…Maternal conditions and pregnancy complications are often associated with prenatal care quality and, if properly identified and cared for, they may increase newborns' chances of survival and reduce risks and harm to maternal-infant health. (4,14,(25)(26)(27) In contrast to the identification of death associated with maternal conditions, reducible deaths by appropriate care provided to newborns in terms of intermediate causes, such as disorders associated with short-term pregnancy and low birth weight, and hypoxia/perinatal asphyxia, decreased after the research regarding specific causes. Causes such as perinatal asphyxia and intrauterine hypoxia are syndromic manifestations resulting from other conditions that must be identified for prevention and appropriate treatment.…”

“…(3) Failures in the care provided to pregnant women, childbirths, and newborns are particularly relevant to death occurrences in the first year of life. (4) Infant deaths remain a public health problem worldwide, especially in poorer countries and regions. Therefore, the World Health Organization considers the reduction of infant mortality by twothirds to be one of the eight millennium developmental goals to be achieved by 2015.…”

Access to care for women during childbirth in university hospitals: characterization and associated factors

“…A gestational age of less than 37 weeks and low weight at birth are determinant factors for neonatal morbidity-mortality and estimated survival of the newborn (12,13) . Thus, factors such as gestational age and weight at birth probably motivated care not being provided at the first service sought by the pregnant woman, with consequent referral to hospitals with greater capacity for medium and high complexity healthcare.…”

Estudo de base populacional sobre mortalidade infantil

“…The method such as linkage with the Live Births Information System (SINASC) and the Mortality Information System (SIM) has been widely used for studies of factors associated with child mortality 7,9 . Some of these factors are well known, such as low mother schooling, low number of prenatal consultations, mother's age, prematurity and low birthweight 4,5,[9][10][11][12][13] . Linkage enables the identification of individuals or records that are part of two or more distinct databases 14 .…”